Discusses options for managing perimenopause- and menopause-related hot flashes. Explains what hot flashes are. Discusses lifestyle changes that may help hot flashes. Looks at hormone therapy (HT) and treatment with medicines and herbs.

Menopause: Managing Hot Flashes

Introduction

Most women experience
hot flashes at some point before or after
menopause, when their
estrogen levels are declining. While some women have
few to no hot flashes, others have them numerous times each day. If hot flashes
are disrupting your sleep or daily life, you are no doubt looking for relief.
Fortunately, you have a number of self-care and medical treatment options that
can help you manage your symptoms.

No matter how disruptive and frustrating they
may be, hot flashes are not a sign of a medical problem. They are a normal
response to natural hormonal changes in your body. Hot flashes usually subside
after the first or second year following menopause, when estrogen levels
stabilize at a low level.

Tobacco use, heavy alcohol use, and stress tend to make hot
flashes worse. By avoiding these risk factors, exercising regularly, and eating
well, you can prevent or reduce hot flashes.

The body-mind
connection is a powerful element of hot flashes and emotional symptoms.
Rhythmic breathing exercises (paced respiration), which help you meditate and
relax, may reduce your hot flashes.

Treatments that may either
reduce or stop moderate to severe hot flashes include short-term, low-dose
estrogen (hormone therapy), certain antidepressant and blood
pressure medicines, and the herb black cohosh.

If you
have experienced hot flashes, you're already well aware that they are sudden
sensations of intense body heat, often with heavy sweating and reddening of the
head, neck, and chest or the entire body. At night, they commonly cause
drenching "night sweats," making them a cause of sleep problems for
perimenopausal and
postmenopausal women.

During a typical
hot flash, your skin temperature rises. Although you may feel very warm during
a hot flash, because of the heat lost by your body's cooling mechanism
(perspiration), your body temperature may actually drop. Some women feel chilly
after a hot flash, and some women feel the chill without the flash.

The biochemical cause of hot flashes is not well understood. But
they are linked to declining
estrogen levels, and they do seem to be made worse by
stress, heavy alcohol use, and cigarette smoking. Although menopausal hot
flashes can be disruptive, frustrating, and at times embarrassing, they are
medically harmless. They are not a sign of a medical problem, nor do they cause
medical problems.

It is normal for hot flashes to:

Happen in women of all ages when they are upset
or embarrassed.

Happen during the perimenopausal years before
menopause, when estrogen levels fluctuate. They are most common, most frequent,
and most intense during the 2 years following
menopause (postmenopause), when estrogen declines.

Be accompanied by mild to severe heart palpitations, anxiety, or
irritability. In rare cases,
panic attacks are triggered at the same time as hot
flashes, usually in women who have a history of panic attacks.

Be
especially severe in women who become menopausal from chemotherapy,
antiestrogen treatment for breast cancer, or surgical removal of the ovaries.

Subside within a couple of years after menopause. But some women
do continue to have hot flashes for years after menopause. There is no reliable
method for predicting whether, when, or how long you will have hot
flashes.

Hot flashes are uncommon in various places around the
world. More research is necessary before experts can identify specific
factors about American women's environment and lifestyle that make hot flashes
a common problem.

Test Your Knowledge

Hot flashes are a normal part of perimenopause and
postmenopause and are caused by declining estrogen levels.

Hot flashes are a normal part
of
perimenopause for most women. If yours are mild or
infrequent, there is no need to treat them. But it's common to look for relief
of moderate to severe or frequent hot flashes that disrupt your daily life and
sleep.

You may not have to "treat" hot flashes to prevent them or
get them under control. Making healthy lifestyle choices is your best and first
choice for hot flashes and can make a big difference in how your body handles
the transition to menopause. But if hot flashes are frequent and powerful,
additional treatment may be needed to help you get enough sleep or lead a
predictable daily life.

You can manage hot
flashes by making certain lifestyle choices. You can also take daily medicine.
Some measures help prevent or reduce hot flashes, and others can make you more
comfortable when you're having a hot flash. If you are looking for additional
treatment measures, you have a few options to choose from.

Lifestyle choices for preventing or reducing hot flashes

Eat smaller, more frequent meals to avoid the heat
generated by digesting large amounts of food.

Make healthy eating a priority.

Do not smoke or
use other forms of tobacco.

Stay cool.

Keep your environment cool, or use a
fan.

Dress in layers, so you can remove clothes as
needed.

Wear natural fabrics, such as cotton and
silk.

Sleep with fewer blankets.

Reduce stress.

Get regular
physical exercise.

Use relaxation techniques, such as
breathing exercises,
yoga, or
biofeedback. Using a breathing-for-relaxation exercise
called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment options for hot flashes

Short-term, low-dose
hormone therapy (HT) can reduce or stop
hot flashes and other perimenopausal symptoms by raising your body's estrogen
level. Use the lowest dose needed for the shortest possible time and have
regular checkups. This is because HT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, and dementia in a small number of women. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.1 If you have a history of cardiovascular disease or breast
cancer, avoid using estrogen for hot-flash relief—other options are available.

Estrogen-progestin birth control pills (before
menopause) can reduce or stop hot flashes and other perimenopausal symptoms by
evening out fluctuating hormones. Don't use estrogen for hot-flash relief if
you are older than 35 and smoke; have
diabetes, cardiovascular disease, or breast cancer; or
have a
family history of breast cancer.

Antidepressant medicine can reduce the number and
severity of hot flashes by improving the brain's use of serotonin, which helps
regulate body temperature. Side effects are possible.
This type of medicine is a good choice if hot flashes, irritability, or mood
swings are your only perimenopausal symptom.2

Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent.3 This type of medicine is a good choice if
hot flashes are your only perimenopausal symptom, especially if you have high
blood pressure.

Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.2

Black cohosh may reduce or prevent hot flashes,
depression, and anxiety. As with HT, have regular checkups when taking
black cohosh.

Some women eat and
drink a lot of soy to even out hot flashes and other perimenopausal symptoms.
So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.4

Test Your Knowledge

You can help make yourself more comfortable during a
hot flash if you dress in layers and keep a fan handy.

Dressing in layers allows you to remove
clothing during a hot flash. This may make your hot flash less severe and also
less noticeable to others. Using a fan can also help cool the surrounding air
and make you more comfortable.

Dressing in layers allows you to remove
clothing during a hot flash. This may make your hot flash less severe and also
less noticeable to others. Using a fan can also help cool the surrounding air
and make you more comfortable.

Regular exercise and the use of relaxation techniques,
such as
meditative breathing exercises,
yoga, and
biofeedback, may decrease the frequency and severity
of your hot flashes. Using a breathing-for-relaxation exercise may reduce hot
flashes and emotional symptoms.

If you are using an alternative medicine or
herbal supplement, make sure your doctor knows. Alternative medicines and
herbal supplements don't have to have the same testing or purity standards as
prescription and other nonprescription medicines. Tell your doctor the type and
amount you are taking, and how long you have been taking it. If you are taking
black cohosh, have regular checkups to make sure it is not causing any medical
problems.

If you are using an alternative medicine or
herbal supplement, make sure your doctor knows. Alternative medicines and
herbal supplements don't have to have the same testing or purity standards as
prescription and other nonprescription medicines. Tell your doctor the type and
amount you are taking, and how long you have been taking it. If you are taking
black cohosh, have regular checkups to make sure it is not causing any medical
problems.

If you are having problems
with hot flashes, discuss them with your doctor at your next regularly
scheduled appointment. If your hot flashes are so severe that they are
disrupting your sleep or affecting another area of your life, call your doctor
to discuss your hot flashes.

Organizations

American Congress of Obstetricians and Gynecologists
(ACOG)

409 12th Street SW

P.O. Box 70620

Washington, DC 20024-9998

Phone:

1-800-673-8444

Phone:

(202) 638-5577

Email:

resources@acog.org

Web Address:

www.acog.org

American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.

North American Menopause Society (NAMS)

5900 Landerbrook Drive

Suite 390

Mayfield Heights, OH 44124

Phone:

(440) 442-7550

Fax:

(440) 442-2660

Email:

info@menopause.org

Web Address:

www.menopause.org

The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS website has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.

Office on Women's Health

Department of Health and Human Services

200 Independence Avenue, SW Room 712E

Washington, DC 20201

Phone:

1-800-994-9662(202) 690-7650

Fax:

(202) 205-2631

TDD:

1-888-220-5446

Web Address:

www.womenshealth.gov

The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.

References

Citations

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.

North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.

Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.

North American Menopause Society (2011). The role of soy isoflavones in menopausal health: Report of the North American Menopause Society. Menopause, 18(7): 732–753.

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